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Li N, Li JW, Qian Y, Liu YJ, Qi XZ, Chen YL, Gao Y, Chang C. Axillary lymph node metastasis in pure mucinous carcinoma of breast: clinicopathologic and ultrasonographic features. BMC Med Imaging 2024; 24:108. [PMID: 38745134 PMCID: PMC11094983 DOI: 10.1186/s12880-024-01290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The purpose of this research is to study the sonographic and clinicopathologic characteristics that associate with axillary lymph node metastasis (ALNM) for pure mucinous carcinoma of breast (PMBC). METHODS A total of 176 patients diagnosed as PMBC after surgery were included. According to the status of axillary lymph nodes, all patients were classified into ALNM group (n = 15) and non-ALNM group (n = 161). The clinical factors (patient age, tumor size, location), molecular biomarkers (ER, PR, HER2 and Ki-67) and sonographic features (shape, orientation, margin, echo pattern, posterior acoustic pattern and vascularity) between two groups were analyzed to unclose the clinicopathologic and ultrasonographic characteristics in PMBC with ALNM. RESULTS The incidence of axillary lymph node metastasis was 8.5% in this study. Tumors located in the outer side of the breast (upper outer quadrant and lower outer quadrant) were more likely to have lymphatic metastasis, and the difference between the two group was significantly (86.7% vs. 60.3%, P = 0.043). ALNM not associated with age (P = 0.437). Although tumor size not associated with ALNM(P = 0.418), the tumor size in ALNM group (32.3 ± 32.7 mm) was bigger than non-ALNM group (25.2 ± 12.8 mm). All the tumors expressed progesterone receptor (PR) positively, and 90% of all expressed estrogen receptor (ER) positively, human epidermal growth factor receptor 2 (HER2) were positive in two cases of non-ALNM group. Ki-67 high expression was observed in 36 tumors in our study (20.5%), and it was higher in ALNM group than non-ALNM group (33.3% vs. 19.3%), but the difference wasn't significantly (P = 0.338). CONCLUSIONS Tumor location is a significant factor for ALNM in PMBC. Outer side location is more easily for ALNM. With the bigger size and/or Ki-67 higher expression status, the lymphatic metastasis seems more likely to present.
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Affiliation(s)
- Na Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu Qian
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ya-Jing Liu
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiu-Zhu Qi
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ya-Ling Chen
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yi Gao
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Thai JN, Lerwill MF, Chou SHS. Spectrum of Mucin-containing Lesions of the Breast: Multimodality Imaging Review with Pathologic Correlation. Radiographics 2023; 43:e230015. [PMID: 37792588 DOI: 10.1148/rg.230015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Mucin-containing lesions of the breast encompass a wide range of benign and malignant processes. The spectrum of histologic findings includes incidental mucus-filled benign cysts or ducts, mucocele-like lesions (MLLs), mucin-producing ductal carcinoma in situ, and invasive mucinous carcinoma. MLL is characterized by the presence of mucin-containing cysts that are typically associated with extravasated stromal mucin. MLL is often benign but can be associated with epithelial atypia or malignancy. Mucinous carcinoma represents the malignant end of the spectrum of mucinous lesions of the breast. Evidence-based literature supports a conservative approach for benign MLLs without associated atypia or malignancy, reserving excision for those lesions exhibiting such pathologic features. The most common imaging finding for MLL is microcalcifications at mammography. No specific imaging feature is predictive of malignant outcome at surgical excision. Invasive mucinous carcinoma is a heterogeneous breast tumor subtype, as defined according to the World Health Organization criteria. Mucinous carcinomas are categorized into pure (>90% mucinous component) or mixed (10%-90% mucinous component) subtypes. Pure mucinous carcinomas are generally associated with excellent prognosis and survival, with a few exceptions. Mixed mucinous carcinomas do not have the same favorable prognosis and instead behave similarly to invasive breast carcinomas of no special type. Characteristic diagnostic imaging features can be identified for mucinous carcinoma based on its mucinous and nonmucinous contents. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Janice N Thai
- From the Department of Radiology, Division of Breast Imaging (J.N.T, S.H.S.C), and Department of Pathology (M.F.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Melinda F Lerwill
- From the Department of Radiology, Division of Breast Imaging (J.N.T, S.H.S.C), and Department of Pathology (M.F.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Shinn-Huey S Chou
- From the Department of Radiology, Division of Breast Imaging (J.N.T, S.H.S.C), and Department of Pathology (M.F.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
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Effect of postoperative radiotherapy in women with localized pure mucinous breast cancer after lumpectomy: a population-based study. Radiat Oncol 2022; 17:119. [PMID: 35799256 PMCID: PMC9264504 DOI: 10.1186/s13014-022-02082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Pure mucinous breast cancer is a rare subtype of invasive breast cancer with favorable prognosis, in which the effect of postoperative radiotherapy remains unclear. We aimed to investigate the prognostic value of postoperative radiotherapy in women with localized pure mucinous breast cancer after lumpectomy.
Methods We conducted a retrospective cohort study to compare the effectiveness of postoperative radiotherapy (RT) and omitting postoperative radiotherapy (non-RT) in patients with first primary T1-2N0M0 (T ≤ 3 cm) pure mucinous breast cancer who underwent lumpectomy between 1998 and 2015 using the Surveillance, Epidemiology, and End Results (SEER) database. Breast cancer-specific survival (BCSS) was compared between RT and non-RT groups using Kaplan–Meier method and Cox proportional hazards regression model. Propensity score matching (PSM) was carried out to balance cohort baselines. In addition, an exploratory analysis was performed to verify the effectiveness of RT in subgroup patients. Results Of 7832 eligible patients, 5352 (68.3%) underwent lumpectomy with postoperative RT, 2480 (31.7%) received lumpectomy without postoperative RT. The median follow-up duration was 92 months. The median age was 66 years in the RT group and 76 years in the non-RT group.The 15-year BCSS was 94.39% (95% CI, 93.08% to 95.35%) in the RT group versus 91.45%(95% CI, 88.93% to 93.42%) in the non-RT group (P < 0.001). The adjusted hazard ratio for BCSS was 0.64 (95% CI, 0.49 to 0.83; P = 0.001) for RT group versus non-RT group. After propensity score matching, similar results were yielded. Adjuvant RT reduced the 15-year risk of breast cancer death from 7.92% to 6.15% (P = 0.039). The adjusted hazard ratio for BCSS were 0.66 (95%CI, 0.47 to 0.92; P = 0.014) for RT group versus non-RT group. The benefit of RT was well consistent across subgroup patients. Conclusion Among women with T1-2N0M0 (tumor size ≤ 3 cm) pure mucinous breast cancer, the addition of RT after lumpectomy was significantly associated with a reduced incidence of breast cancer death compared with non-RT, and the magnitude of benefit may be modest. This suggests that postoperative RT is recommended in the treatment of localized pure mucinous breast cancer.
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Construction of a Prognostic Nomogram Model for Patients with Mucinous Breast Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1230812. [PMID: 35368964 PMCID: PMC8967531 DOI: 10.1155/2022/1230812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022]
Abstract
Objective The objective of the study is to develop a nomogram for estimating three- and five-year survival rates in mucinous breast cancer patients. Methods Between 2010 and 2016, the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) were searched as a data source for patients associated with mucinous breast cancer (MBC). A total of 3964 patients were recruited after screening. The multivariate Cox model and the univariate Kaplan-Meier (KM) approach were employed to evaluate the independent prognostic markers, followed by developing a nomogram for estimating three- and five-year survival rates in MBC patients. Consequently, the consistency index (C-index) was employed to assess the predictive accuracy of the generated nomogram. Results Age, race, T stage, M stage, surgery, and radiotherapy were all independent predictive biomarkers for the MBC patients (P < 0.05). The nomogram was finally developed based on the underlined factors. Furthermore, the C-index of 0.803 and reliable calibration curves were obtained in the nomogram's assessment. Conclusions In patients with mucinous breast cancer, the proposed nomogram provides a viable tool for accurate prognostic prediction. In clinical practice, it could serve as a personalized diagnosis tool, estimate prognosis, and help in suggesting treatment plans for patients with MBC.
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Zhang H, Zhang N, Li Y, Liang Y, Yang Q. Evaluation of efficacy of chemotherapy for mucinous carcinoma: a surveillance, epidemiology, and end results cohort study. Ther Adv Med Oncol 2020; 12:1758835920975603. [PMID: 33425023 PMCID: PMC7758869 DOI: 10.1177/1758835920975603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background In this study, we investigated the impact of chemotherapy on breast cancer-specific survival (BCSS) in patients with mucinous carcinoma using the surveillance, epidemiology, and end results (SEER) database. Methods A large-scale SEER-based retrospective analysis was conducted; 13,329 patients with mucinous carcinoma from 1994 to 2014 were identified. Clinicopathological characteristics were compared using the chi-square test. BCSS curves were generated using the Kaplan-Meier method. The prognostic significance of all demographic and clinicopathological characteristics and treatment patterns were calculated using univariate and multivariate regression analyses. Results Mucinous carcinoma was demonstrated to be less aggressive than invasive ductal carcinoma and predicted a better prognosis in the Kaplan-Meier analysis (hazard ratios = 0.336, 95% confidence interval: 0.308-0.368, p < 0.001). Univariate and multivariate analyses revealed that chemotherapy did not provide any additional benefit for patients with mucinous carcinoma. Predictors for receiving chemotherapy were younger age, estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor receptor 2-positive status, higher grade, larger tumor size, lymph node involvement, radiation reception, and mastectomy. Further subgroup analysis verified that regardless of the hormone receptor (HR) and lymph node (LN) status, patients did not benefit from chemotherapy. Conclusion Our study showed that patients with HR+/LN- mucinous carcinoma did not benefit from chemotherapy and that chemotherapy could not improve the survival of all subtypes of mucinous carcinoma based on large-scale SEER data. These results support that patients with mucinous carcinoma could be exempt from chemotherapy. Additional research is needed to further evaluate the impact of adjuvant treatments, particularly in patients with favorable histology.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong 250012, China
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Clinicopathological Study of Mucinous Carcinoma of Breast with Emphasis on Cytological Features: A Study at Tertiary Care Teaching Hospital of South India. J Lab Physicians 2020; 12:68-75. [PMID: 32792796 PMCID: PMC7419167 DOI: 10.1055/s-0040-1714935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction
Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Depending on the amount of mucin, it is classified into pure mucinous carcinoma (> 90%, PMC) and mixed mucinous carcinoma (MMC; < 90%). In comparison to most common subtypes, MC is having better prognosis. There exist clinicopathological differences among PMC and MMC and also MC and IDC-NOS.
Materials and Methods
MCs diagnosed between January 2012 and December 2017 were included. Fine needle aspiration cytology smears were screened for cellularity, ECM, nuclear pleomorphism, signet ring cells (SRC), mucinophages, and myxovascular fragments (MVF). Histopathology slides were screened to confirm the diagnosis. Immunohistochemistry slides were graded as per the standard protocol. Statistical analyses were performed by SPSS software.
Results
In the present study, MC constituted 3.3%. The mean age of the patients was 50.9 years. ECM, mucinophages, and SRC were the key diagnostic cytological features. The PMC and MMC were clinicopathologically distinct with respect to gross findings and lymph node status. MMCs were highly proliferative. The mean duration of follow-up was 24.5 months. Complications were more common in MMC than PMC. Lymph node involvement is the key prognostic factor and it is independent of other prognostic factors like age, size, and hormonal receptor status.
Conclusion
PMC are rare subtype of breast cancer. The diagnostic cytological features are ECM, MVF, and SRC. MMC and PMC are clinicopathologically and genetically distinct.
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Yu P, Liu P, Zou Y, Xie X, Tang H, Li N, Xie X, Ye F. Breast-conserving therapy shows better prognosis in mucinous breast carcinoma compared with mastectomy: A SEER population-based study. Cancer Med 2020; 9:5381-5391. [PMID: 32515157 PMCID: PMC7402828 DOI: 10.1002/cam4.3202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/12/2022] Open
Abstract
Background Mucinous breast carcinoma (MBC) is a relatively rare pathological type of breast cancer. Compared with mastectomy in MBC, the effect and safety of breast‐conserving therapy (BCT) remains unclear. Therefore, we investigated the long‐term prognosis of BCT and mastectomy in T1‐2 stage mucinous breast carcinoma via the Surveillance, Epidemiology, and End Results (SEER) database. Methods Totally, 8830 patients who were diagnosed of mucinous breast carcinoma between 2004 and 2014 from SEER database were reviewed retrospectively. Cox proportional hazards model and Kaplan‐Meier method were performed for evaluating the relationship between surgical method and prognosis. Results One thousand three hundred and twenty (14.9%) patients underwent mastectomy and 7510 (85.1%) underwent BCT. The median follow‐up time was 77 months. There were more non‐Hispanic white, married, and younger (<65 years) patients, as well as lower stage of tumor sizes, lymph nodes and more favorable histologic grade, ER positive, and PR positive in BCT group (P < .05). Patients in BCT group had relatively better overall survival (OS) than those in mastectomy group. The risk of death from any cause in BCT group was lower than that in mastectomy group significantly (HR = 0.786, 95% CI: 0.703‐0.879, P < .001), while no difference significantly was observed in breast cancer‐specific survival (BCSS) between BCT and mastectomy groups. In stratified analysis according to T stage, BCT group had better OS than mastectomy group for patients of T1 stage (HR = 0.679, 95% CI: 0.589‐0.781, P < .001) or T2 stage (HR = 0.769, 95% CI: 0.646‐0.915, P = .003). In stratified analysis according to the different ages, BCT showed OS benefit in patients at the age of 50‐64 years (HR = 0.587, 95% CI: 0.408‐0.846, P = .004) and the age of 65‐79 years (HR = 0.636, 95% CI: 0.535‐0.758, P = .001). For patients younger than 50 years or not younger than 80 years, there was no difference significantly observed in OS between BCT and mastectomy groups (P > .05).While for patients who received BCT, the use of radiotherapy showed OS benefit. Conclusions This large population‐based study indicated patients who received BCT had better prognosis than those received mastectomy in T1‐2 stage MBC, especially in patients at the age of 50‐79 years. The use of radiotherapy showed OS benefit in patients receiving BCT. Breast‐conserving therapy might be preferred over mastectomy especially in locoregional treatment of T1‐2 stage MBC.
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Affiliation(s)
- Ping Yu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Peng Liu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yutian Zou
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinhua Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Na Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Feng Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Kim HS, Yoo TK, Park WC, Chae BJ. The prognostic value of HER2 status and efficacy of anti-HER2 therapy in patients with HR-positive mucinous breast cancer: a nationwide study from the Korean Breast Cancer Society. Breast Cancer Res Treat 2020; 180:461-470. [PMID: 32020434 DOI: 10.1007/s10549-020-05550-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/27/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The effect of human epidermal growth factor receptor 2 (HER2) status on mucinous carcinoma (MC) of the breast is unknown due to the rarity of HER2-positive cases. We evaluated the prognostic value of HER2 status and the efficacy of anti-HER2 therapy in patients with hormone receptor (HR)-positive MC. METHODS From the data of 154,661 patients recorded in the Korean Breast Cancer Registry between January 1990 and August 2016, 3076 (2.0%) were diagnosed with MC. Overall survival (OS) according to HER2 status and anti-HER2 therapy was analyzed using Kaplan-Meier estimates. Multivariate analysis was performed using the Cox proportional hazards model to estimate the adjusted hazards ratio (HR) for clinicopathologic factors. RESULTS A total of 2716 HR-positive MC patients were enrolled and followed up for a median 100.1 months. Of these, 2094 (77.1%) were HER2-negative and 228 (8.4%) were HER2-positive. HR-positive, HER2-positive MC patients had more advanced pathologic tumor stages (T3 or T4) (p = 0.001), more axillary lymph node involvement (p < 0.001), higher nuclear grade (p < 0.001), and more lymphovascular invasion (p = 0.012) than HER2-negative patients. Subgroup analysis of HR-positive, node-positive MC showed that HER2-positive MC was an independent prognostic factor for OS (HR = 2.657; 95% CI, 1.665-4.241; p < 0.001). HR-positive, node-positive, and HER2-negative MC had significantly longer OS than HER2-positive MBC (p = 0.017). The node-positive subgroup that received anti-HER2 therapy had increased OS, although not significantly (p = 0.224). CONCLUSION Our nationwide database study revealed that HER2-positive status was associated with worse prognosis in HR-positive and node-positive MC. Anti-HER2 therapy might be beneficial in HR-positive, node-positive, and HER2-positive MC.
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Affiliation(s)
- Hyung Suk Kim
- Division of Breast Surgery, Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Tae Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Medicine, Seoul, Korea
| | - Woo Chan Park
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Medicine, Seoul, Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
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Kim HS, Lee JU, Yoo TK, Chae BJ, Son D, Kim YJ, Park WC. Omission of Chemotherapy for the Treatment of Mucinous Breast Cancer: A Nationwide Study from the Korean Breast Cancer Society. J Breast Cancer 2019; 22:599-612. [PMID: 31897333 PMCID: PMC6933040 DOI: 10.4048/jbc.2019.22.e46] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/10/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Mucinous breast carcinoma (MBC) is a rare type of breast cancer. Although patients with MBC may have a better prognosis than that of patients with invasive ductal carcinoma, many clinicians administer adjuvant chemotherapy regimens similar to those for other breast tumors. Using data from a nationwide clinical database, this study evaluated the significance of adjuvant systemic chemotherapy and whether it can be omitted in MBC patients. METHODS We included 3,076 patients with a diagnosis of MBC recorded in the Korean Breast Cancer Registry between January 1990 and August 2016. We used the Kaplan-Meier method to analyze breast cancer-specific survival (BCCS) and overall survival (OS). Multivariate analysis was performed using a Cox proportional hazard ratio (HR) model to estimate the adjusted HR for each prognostic factor. RESULTS A total of 2,988 MBC patients were enrolled and followed-up for a median of 100 months (range, 2-324 months). Multivariate analysis revealed that axillary lymph node (ALN) metastasis and estrogen receptor (ER) negativity were significant prognostic factors for BCSS. Meanwhile, old age, pathologic tumor stage, and ALN metastasis were significant prognostic factors for OS. Subgroup analysis of ER-positive MBC showed that ALN metastasis was a significant prognostic factor for BCSS. Additionally, old age, pathologic tumor stage, and ALN metastasis were prognostic factors for OS. Ultimately, ALN metastasis was the most statistically significant prognostic factor for MBC. However, chemotherapy had no significant effect on BCSS and OS. The Kaplan-Meier curves of BCSS and OS based on pathologic tumor and nodal stages and age revealed that chemotherapy did not statistically significantly improve prognosis, except for the N3 stage. CONCLUSION Our large retrospective analysis revealed that adjuvant chemotherapy provided little benefit to improve the prognosis of most ER-positive MBC patients. Therefore, chemotherapy can be omitted in the treatment of most ER-positive MBC.
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Affiliation(s)
- Hyung Suk Kim
- Division of Breast Surgery, Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jong Uk Lee
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Donghee Son
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Yun Jin Kim
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Woo Chan Park
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jang Y, Jung H, Kim HN, Seo Y, Alsharif E, Nam SJ, Kim SW, Lee JE, Park YH, Cho EY, Cho SY. Clinicopathologic characteristics of HER2-positive pure mucinous carcinoma of the breast. J Pathol Transl Med 2019; 54:95-102. [PMID: 31718120 PMCID: PMC6986976 DOI: 10.4132/jptm.2019.10.24] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pure mucinous carcinoma (PMC) is a rare type of breast cancer, estimated to represent 2% of invasive breast cancer. PMC is typically positive for estrogen receptors (ER) and progesterone receptors (PR) and negative for human epidermal growth factor receptor 2 (HER2). The clinicopathologic characteristics of HER2-positive PMC have not been investigated. METHODS Pathology archives were searched for PMC diagnosed from January 1999 to April 2018. Clinicopathologic data and microscopic findings were reviewed and compared between HER2-positive PMC and HER2-negative PMC. We also analyzed the differences in disease-free survival (DFS) and overall survival according to clinicopathologic parameters including HER2 status in overall PMC cases. RESULTS There were 21 HER2-positive cases (4.8%) in 438 PMCs. The average tumor size of HER2-positive PMC was 32.21 mm (± 26.55). Lymph node metastasis was present in seven cases. Compared to HER2-negative PMC, HER2-positive PMC presented with a more advanced T category (p < .001), more frequent lymph node metastasis (p = .009), and a higher nuclear and histologic grade (p < .001). Microscopically, signet ring cells were frequently observed in HER2-positive PMC (p < .001), whereas a micropapillary pattern was more frequent in HER2-negative PMC (p = .012). HER2-positive PMC was more frequently negative for ER (33.3% vs. 1.2%) and PR (28.6% vs. 7.2%) than HER2-negative PMC and showed a high Ki-67 labeling index. During follow-up, distant metastasis and recurrence developed in three HER2-positive PMC patients. Multivariate analysis revealed that only HER2-positivity and lymph node status were significantly associated with DFS. CONCLUSIONS Our results suggest that HER2-positive PMC is a more aggressive subgroup of PMC. HER2 positivity should be considered for adequate management of PMC.
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Affiliation(s)
- Yunjeong Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Hera Jung
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Han-Na Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Youjeong Seo
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Emad Alsharif
- 2Division of Breast and Endocrine Surgery, Specialized Surgical Unit, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Soo Youn Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
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11
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Jang Y, Cho EY, Cho SY. Human Epidermal Growth Factor Receptor 2-positive Mucinous Carcinoma with Signet Ring Cell Differentiation, Which Showed Complete Response after Neoadjuvant Chemotherapy. J Breast Cancer 2019; 22:336-340. [PMID: 31281734 PMCID: PMC6597410 DOI: 10.4048/jbc.2019.22.e17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/09/2019] [Indexed: 12/27/2022] Open
Abstract
Mucinous carcinoma (MC) is a rare subtype of breast cancer, which is composed of tumor cells floating in the abundant extracellular mucin. This form of cancer is usually estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 (HER2) negative. Here, we present a case of HER2-positive MC with an unusual signet ring cell differentiation. It is very rare that a breast tumor consists entirely of signet ring cells. The tumor showed pathologic complete response (pCR) after neoadjuvant chemotherapy with trastuzumab and pertuzumab. pCR of HER2-positive MC has rarely been described in literature. It is important to consider the biological heterogeneity of MCs for effective management.
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Affiliation(s)
- Yunjeong Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Soo Youn Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
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12
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Ding S, Wu J, Lin C, Chen W, Li Y, Shen K, Zhu L. Predictors for Survival and Distribution of 21-Gene Recurrence Score in Patients With Pure Mucinous Breast Cancer: A SEER Population-Based Retrospective Analysis. Clin Breast Cancer 2018; 19:e66-e73. [PMID: 30396812 DOI: 10.1016/j.clbc.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/27/2018] [Accepted: 10/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pure mucinous breast cancer (PMBC) is a rare pathologic type of breast cancer, the prognostic factors of which have not been clearly defined. This study aimed to analyze the prognostic markers and distribution of 21-gene recurrence score (RS) in patients with PMBC. PATIENTS AND METHODS Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, a retrospective analysis of PMBC cases was conducted. Multivariate analyses were used to evaluate the indicators for prognosis and the correlations between RS and traditional clinicopathologic characteristics. Disease was subdivided into 4 molecular phenotypes using estrogen receptor (ER) status and tumor grade. RESULTS Of the 8048 patients, most had ER-positive and node-negative tumors. Multivariate analysis revealed that molecular phenotype as well as age, race, tumor size, and lymph node status was an independent prognostic factor for patients with PMBC (P < .05). The 5-year breast cancer-specific survival of patients among different phenotypes was significantly different (97.9% for ER-positive and grade I tumor, 96.9% for ER-positive and grade II-III tumor, 96% for ER-negative and grade I tumor, 90.1% for ER-negative and grade II-III tumors, P < .001). The proportions of patients categorized into low, intermediate, and high RS risk group were 64.9%, 31.9%, and 3.2%, respectively. Grade, progesterone receptor status, and age were identified as independent variables associated with RS. CONCLUSION PMBC had favorable biological features and relatively good prognosis. Molecular phenotype as well as age, race, tumor size, and lymph node status were independent prognostic markers. Furthermore, age, progesterone receptor status, and grade could independently predict RS.
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MESH Headings
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Combined Modality Therapy
- Female
- Genetic Testing/methods
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- SEER Program
- Survival Rate
- Transcriptome
- Young Adult
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Affiliation(s)
- Shuning Ding
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caijin Lin
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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13
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Shin YG, Kim EK, Kim MJ, Yoon JH, Moon HJ. Magnetic resonance imaging and pathological characteristics of pure mucinous carcinoma in the breast according to echogenicity on ultrasonography. Ultrasonography 2016; 36:131-138. [PMID: 27764910 PMCID: PMC5381847 DOI: 10.14366/usg.16028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to explore the clinical and pathological characteristics of pure mucinous breast carcinoma (PMBC) according to internal echogenicity on ultrasonography (US). Methods Thirty-three patients with PMBC diagnosed at surgery were included in this study. Cases of PMBC were classified according to internal echogenicity on US. The imaging features on magnetic resonance (MR) imaging and clinicohistopathological characteristics were compared between the hypoechogenic and the isoechogenic to hyperechogenic groups. Results Eleven cases of PMBC (33.3%) exhibited hypoechogenicity on US, while 22 cases (66.7%) exhibited isoechogenicity or hyperechogenicity. Of the isoechogenic to hyperechogenic PMBCs, 95.5% showed a high signal on T2-weighted images, which was a significantly greater percentage than was observed for the hypoechogenic group (54.5%) (P=0.010). Of the hypoechogenic PMBCs, 63.6% showed a washout pattern in the delayed phase, which was substantially more than the result of 23.8% observed for the isoechogenic to hyperechogenic PMBCs (P=0.053). Conclusion PMBCs with isoechogenicity or hyperechogenicity were more likely to show a high signal intensity on T2-weighted images than hypoechogenic PMBCs. However, other MR imaging and clinicohistopathological characteristics were not significantly different between the two groups.
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Affiliation(s)
- Young Gyung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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14
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Skotnicki P, Sas-Korczynska B, Strzepek L, Jakubowicz J, Blecharz P, Reinfuss M, Walasek T. Pure and Mixed Mucinous Carcinoma of the Breast: A Comparison of Clinical Outcomes and Treatment Results. Breast J 2016; 22:529-34. [DOI: 10.1111/tbj.12621] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Piotr Skotnicki
- Department of Surgical Oncology; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
| | - Beata Sas-Korczynska
- Department of Clinical Oncology; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
| | - Lukasz Strzepek
- Department of Surgical Oncology; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
| | - Jerzy Jakubowicz
- Department of Clinical Oncology; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
| | - Pawel Blecharz
- Department of Gynaecological Oncology; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
| | - Marian Reinfuss
- Department of Radiotherapy; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
| | - Tomasz Walasek
- Department of Radiotherapy; Maria Sklodowska-Curie; Memorial Cancer Centre and Institute of Oncology; Krakow Poland
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15
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Ohashi R, Sakatani T, Matsubara M, Watarai Y, Yanagihara K, Yamashita K, Tsuchiya S, Takei H, Naito Z. Mucinous carcinoma of the breast: a comparative study on cytohistological findings associated with neuroendocrine differentiation. Cytopathology 2016; 27:193-200. [PMID: 26804749 DOI: 10.1111/cyt.12298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Mucinous carcinoma (MCA) may show neuroendocrine differentiation (ND), but the cytological features characteristic of ND remains elusive. We compared fine needle aspiration (FNA) findings of MCA between cases with high and low degrees of ND. METHODS Histological sections of 37 MCA cases were immunohistochemically evaluated for expression of chromogranin A and synaptophysin, and were graded as 0 to 3+ degrees of ND. They were divided into low ND (grade 0 and 1+) and high ND (grade 2+ and 3+) groups. Pre-operative FNA samples of each group were assessed for cytological features. RESULTS The mean age of the high ND group (n = 18) was higher than the low ND group (n = 19, P = 0.01). In FNA samples of the high ND group, 17 cases showed moderate to severe degrees of discohesiveness, but low ND cases mainly showed no or only mild discohesiveness (P < 0.001). Nine of the low ND cases displayed overlapped, cohesive cell clusters, whereas, in the high ND cases, the cells were arranged in a loose, flat and monolayered pattern (P = 0.045). Fourteen of the high ND cases had round nuclei, but oval nuclei were predominant in the low ND cases (P = 0.027). The nuclei were eccentrically located in 12 of the high ND cases but were centrally located in 14 of the low ND cases (P = 0.01). CONCLUSIONS Mucinous carcinoma with high ND may be diagnosed by the presence of discohesiveness, a flat, monolayered pattern, and round or eccentrically located nuclei. Features of ND in carcinomas in other organs, such as intracytoplasmic granules and coarse chromatin, may not be reliable cytological features of ND in MCA.
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Affiliation(s)
- R Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - T Sakatani
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Departments of Pathology and Integrative Oncological Pathology, Nippon Medical School, Tokyo, Japan
| | - M Matsubara
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Y Watarai
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yanagihara
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yamashita
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - S Tsuchiya
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Iida Hospital, Nagano, Japan
| | - H Takei
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Z Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Departments of Pathology and Integrative Oncological Pathology, Nippon Medical School, Tokyo, Japan
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16
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Cao AY, He M, Liu ZB, Di GH, Wu J, Lu JS, Liu GY, Shen ZZ, Shao ZM. Outcome of pure mucinous breast carcinoma compared to infiltrating ductal carcinoma: a population-based study from China. Ann Surg Oncol 2012; 19:3019-27. [PMID: 22451233 DOI: 10.1245/s10434-012-2322-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Pure mucinous breast carcinoma (PMBC) is a rare pathologic finding. Few studies have addressed the biologic features of PMBC and prognostic factors among patients with this disease. We performed a study to compare PMBC and invasive ductal carcinoma (IDC) by means of a large database to reliably assess the biologic phenotype and clinical behavior of PMBC. METHODS A total of 2,511 patients who met the inclusion criteria were identified from 1999 to 2010; 2,202 patients had pure IDC and 309 had PMBC. Clinical and biologic features, overall survival, and recurrence/metastasis-free survival (RFS) were compared for both groups. RESULTS PMBC had favorable characteristics including smaller size, lower rates of lymph node positivity, lower stage, higher expression of hormone receptors, and less HER2 overexpression. Patients with PMBC had better 10-year RFS (71 %) than patients with IDC (64 %). Multivariate analysis revealed that node status and tumor, node, metastasis system (TNM) stage were statistically significant prognostic factors for survival. RFS curves stratified for node status revealed a highly significant difference between node negative and node positive patients. Additionally, patients with PMBC underwent breast-conserving surgery (BCS) more frequently than patients with IDC, and the 5-year overall survival rate of the BCS group was not significantly different from the total mastectomy group. CONCLUSIONS PMBC in Chinese women showed less aggressive behavior and had a better prognosis than IDC, and this favorable outcome was maintained after 10 years. Node status and TNM stage appeared to be the most significant predictors of worse prognosis. BCS should be preferred over mastectomy in the treatment of early-stage PMBC.
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Affiliation(s)
- A-Yong Cao
- Breast Cancer Institute, Cancer Hospital/Cancer Institute, Fudan University, Shanghai, People's Republic of China
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17
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Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ, Yang JH. Mucinous carcinoma of the breast in comparison with invasive ductal carcinoma: clinicopathologic characteristics and prognosis. J Breast Cancer 2011; 14:308-13. [PMID: 22323918 PMCID: PMC3268928 DOI: 10.4048/jbc.2011.14.4.308] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/17/2011] [Indexed: 12/02/2022] Open
Abstract
Purpose Mucinous carcinoma (MC) of the breast is a rare histologic type of mammary neoplasm. The objective of this study was to evaluate the long-term disease-free survival (DFS) and overall survival (OS) of MC. Methods We conducted a retrospective analysis of all MC cases reported to a database between 1994 and 2010. Clinicopathological characteristics and survival of 268 MC cases were reviewed and compared with 2,455 invasive ductal carcinoma-not otherwise specified (IDC-NOS) cases. Results The MC cases were of a younger age, involved less lymph nodes, lower stage, more expression of hormonal receptors, and less HER2 overexpression compared to the IDC-NOS cases. The 5-year DFS rate for MC was 95.2% compared to 92.0% for IDC-NOS. The 5-year OS rate for MC was 98.9% compared to 94.9% for IDC-NOS. Multivariate analysis using Cox regression revealed that the mucinous type was a significant prognostic factor for DFS with lower nodal status (N stage) and hormonal therapy. For OS, only N stage was the most significant prognostic factor followed by adjuvant chemotherapy and adjuvant hormonal therapy. Conclusion MC was shown to be associated with a better DFS than IDC-NOS, but it had a similar OS. Nodal status and adjuvant therapy appear to be more significant predictors of prognosis than histologic subtype.
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Affiliation(s)
- Soo Youn Bae
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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18
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Demirci U, Buyukberber S, Cakir T, Poyraz A, Baykara M, Karakus E, Tufan G, Benekli M, Coskun U. Isolated mucinous adrenal metastasis in a breast cancer patient. J Oncol Pharm Pract 2011; 17:444-7. [PMID: 21282299 DOI: 10.1177/1078155210384893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mucinous breast carcinoma (MBC) is a rare histological type of breast cancer and rarely associated with advanced disease. We report a case that had MBC with an isolated adrenal metastasis which was removed by laparoscopic adrenelectomy. This case is unique due to the unexpected metastasis of pure mucinous carcinoma developed after 4 years of hormone therapy.
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Affiliation(s)
- Umut Demirci
- Faculty of Medicine, Department of Medical Oncology, Gazi University, Ankara, Turkey
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19
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Yoo JL, Woo OH, Kim YK, Cho KR, Yong HS, Seo BK, Kim A, Kang EY. Can MR Imaging Contribute in Characterizing Well-circumscribed Breast Carcinomas? Radiographics 2010; 30:1689-702. [DOI: 10.1148/rg.306105511] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Dragoumis DM, Assimaki AS, Tsiftsoglou AP. Pure mucinous carcinoma with axillary lymph node metastasis in a male breast. Breast Cancer 2009; 19:365-8. [DOI: 10.1007/s12282-009-0163-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 07/20/2009] [Indexed: 11/28/2022]
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21
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Kouach J, Elhassani M, Elfazzazi H, Hafidi R, Quamouss O, Rahali Moussaoui D, Dehayni M. Carcinome mucineux multifocal du sein. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/s1776-9817(09)71583-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Morand C, Verrièle V, Valo I, Remoue P, Paillocher N, Chassevent A. Pure mucinous carcinomas of the breast: Prognostic study including DNA flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 76:56-62. [DOI: 10.1002/cyto.b.20436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/25/2008] [Accepted: 05/27/2008] [Indexed: 11/10/2022]
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Di Saverio S, Gutierrez J, Avisar E. A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat 2008; 111:541-7. [PMID: 18026874 DOI: 10.1007/s10549-007-9809-z] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 10/30/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pure mucinous breast carcinoma (PMBC) is a rare histologic type of mammary neoplasm. It has been associated with a better short-term prognosis than infiltrating ductal carcinoma (IDC) but identical long-term survival curves have been reported. The value of tumor size for TNM staging has been challenged because of the mucin content of the lesions. This study presents a large PMBC series with 20 years follow up as compared to IDC. The relative significance of a variety of common prognostic factors is calculated for this uncommon histology. MATERIALS AND METHODS A retrospective analysis of all PMBC cases reported in the SEER database between 1973 and 2002 was conducted. Overall survival (OS) and disease specific survival (DSS) were calculated at 5, 10, 15 and 20 years of follow up. Those curves were compared with all the IDC cases reported into the database during the same period. The prognostic significance of gender, race, laterality, age at diagnosis, T and N status, estrogen and progesterone receptors and administration of radiation therapy was calculated by univariate and multivariate analysis. RESULTS There were 11,422 PMBC patients reported. The median age at diagnosis was 71 years (Range 25-85). Fifty three percent of the tumors were well differentiated, 38% were moderately differentiated and the remaining 9% were poorly differentiated or anaplastic. The majority of the tumors were located in the upper outer quadrant (44%) the other 56% were roughly evenly divided between the upper inner, lower inner, lower outer and central quadrants. Eighty six percent of the patients had only localized disease at the time of surgery without nodal or distant disease while 12% had regional nodal involvement and 2% had distant metastases. The PMBC cases showed a better differentiation with lesions of lesser grade and more frequent ER/PR expression, smaller size and lesser nodal involvement when compared to the IDC cases of the same period. Kaplan Meier survival curves revealed a 5 years. breast cancer specific survival rate of 94%. Although slowly decreasing with time, 10, 15 and 20 years survival were 89%, 85% and 81% respectively compared to 82% (5 year), 72% (10 year), 66% (15 year) and 62% (20 year) for IDC. There were no significant differences in overall survival. Multivariate analysis by Cox regression revealed the nodal status (N) to be the most significant prognostic factor followed by age, tumor size (T), progesterone receptors and nuclear grade. Disease specific survival curves stratified for nodal status revealed a highly significant difference between node negative and node positive patients. The addition of radiation therapy after surgery did not significantly improve overall survival. CONCLUSIONS This large retrospective comparative analysis confirms the less aggressive behavior of PMBC compared to IDC. This favorable outcome is maintained after 20 years. This tumor presents typically in older patients and is rarely associated with nodal disease. Positive nodal status appears to be the most significant predictor of worse prognosis.
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MESH Headings
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Proportional Hazards Models
- Retrospective Studies
- Risk Assessment
- Risk Factors
- SEER Program
- Time Factors
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Salomone Di Saverio
- Department of Surgery, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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24
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Expression of androgen, estrogen and progesterone receptors in mucinous carcinoma of the breast. Kaohsiung J Med Sci 2008; 24:227-32. [PMID: 18508419 DOI: 10.1016/s1607-551x(08)70146-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hormone receptors play important roles in breast cancer. We investigated the expression of hormone receptors in breast cancer to evaluate the importance of hormone receptors in the clinicopathology of breast cancer. Androgen receptor (AR), estrogen receptor (ER) and progesterone receptor (PR) expression characteristics were evaluated using immunohistochemistry stain, comparing patient age, tumor size and axillary lymph node status for 23 pure mucinous and 105 non-mucinous infiltrating ductal carcinomas in the human female breast. Mucinous carcinoma with axillary lymph node metastasis occurred less frequently than non-mucinous carcinoma (11.8% vs. 55.2%; p = 0.01). Compared with the non-mucinous type, mucinous carcinoma specimens showed less AR expression (21.7% vs. 51.4%; p = 0.01) but more ER expression (78.3% vs. 52.4%; p = 0.02). In addition, AR expression was also associated with ER and/or PR coexpression (37/74, 50%) in infiltrating ductal carcinoma. But only three of 20 (15%) mucinous carcinoma specimens with AR expression had associated ER and/or PR coexpression. Our findings revealed that mucinous carcinoma samples from the breast show distinct clinicopathologic and hormone receptor expression features compared to non-mucinous carcinoma.
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25
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Stita W, Trabelsi A, Jaidene L, Ben Abdelkerim S, Hmissa S, Sriha B, Korbi S. Le carcinome mucineux pur du sein : à propos de 18 cas. IMAGERIE DE LA FEMME 2008. [DOI: 10.1016/s1776-9817(08)77198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Dhillon R, Depree P, Metcalf C, Wylie E. Screen-detected mucinous breast carcinoma: potential for delayed diagnosis. Clin Radiol 2006; 61:423-30. [PMID: 16679116 DOI: 10.1016/j.crad.2005.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 10/05/2005] [Accepted: 10/07/2005] [Indexed: 10/24/2022]
Abstract
AIM To describe the imaging features of 34 screen-detected mucinous carcinomas lesions. MATERIALS AND METHODS The BreastScreen Western Australia (WA) database between January 1991 and December 2003 was searched. During this period, 214,507 women were screened and 2745 cases of invasive carcinoma and 45 cases of mucinous carcinoma were recorded. Case notes, radiology films and pathology reports of patients with mucinous carcinoma were reviewed. Thirty-four radiologically detected pure mucinous carcinomas are described. RESULTS Of the pure mucinous carcinomas, the average age at diagnosis was 65 years (range 48-82 years), which was higher than that of other women with breast cancer (average age 60 years) screened at BreastScreen WA. Characteristic mammographic features of mucinous carcinoma are well-circumscribed masses with lobulated margins (26/34). Only 39% (11/28) of tumours were detected at ultrasound, as the smaller lesions less than 15mm in diameter were often isoechoic with normal fat. Where histological grade was reported at excision, most (25/26) were low to medium-grade tumours (Bloom, Richardson and Elston grade I and II). A significant number of lesions (13/34) were evident on the previous screening examination where they were misinterpreted as benign lesions. However, none of these cases had positive axillary lymph nodes at final diagnosis. CONCLUSION Although mammographically benign appearances of mucinous carcinoma caused a delay in diagnosis in 38% of the present cases, mucinous breast carcinomas have a favourable prognosis, as they are often low-grade tumours and rarely metastasize. Delay in diagnosis for these tumours in a screening programme may not lead to a significant adverse outcome for most women.
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Affiliation(s)
- R Dhillon
- Department of Diagnostic and Interventional Imaging, Royal Perth Hospital, WA, Australia.
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Mizuta Y, Mizuta N, Sakaguchi K, Hachimine Y, Sawai K, Urasaki K, Yasukawa S, Nakajima H. A case of non-metastatic giant mucinous carcinoma of the breast. Breast Cancer 2005; 12:337-40. [PMID: 16286917 DOI: 10.2325/jbcs.12.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A surgically resected case of giant mucinous carcinoma of the breast that had remained untreated for 2 years is reported. A 64-year-old postmenopausal woman presented with a large right breast mass (17.4 x 16.5 x 14.5 cm). Although she had noticed a mass in the right breast 2 years previously, she had not sought treatment. Mucinous carcinoma was diagnosed by core needle biopsy and she underwent right modified radical mastectomy with a free skin graft. There were no lymph node metastases or distant metastases. Fourteen months postoperatively, she remains well without evidence of tumor recurrence. Although several reports have suggested that pure mucinous carcinoma of the breast has a favorable prognosis, we need to follow this case until the clinical behavior and the outcome become clear.
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Affiliation(s)
- Yuki Mizuta
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kamikyo-ku, Kyoto, 602-0841, Japan.
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Hsu YH, Shaw CK. Expression of p53, DCC, and HER-2/neu in Mucinous Carcinoma of the Breast. Kaohsiung J Med Sci 2005; 21:197-202. [PMID: 15960065 DOI: 10.1016/s1607-551x(09)70188-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We investigated the clinicopathologic and oncoprotein expression characteristics of 11 pure mucinous and 76 non-mucinous infiltrating ductal carcinomas in the human female breast. We compared patient age, tumor size, axillary lymph node status, and the expression of estrogen receptor (ER), progesterone receptor (PR), deleted-in-colon cancer (DCC), HER-2/neu, and p53. Mucinous carcinoma with axillary lymph node metastasis occurs less frequently than non-mucinous carcinoma (0% vs 63.1%; p = 0.0018). Compared with the non-mucinous type, mucinous carcinoma specimens have more DCC expression (100% vs 48.7%; p = 0.0027) and more ER expression (90.9% vs 26.9%; p = 0.0023), but less HER-2/neu overexpression (0% vs 38.1%; p = 0.0302). We confirmed that mucinous carcinoma samples from the breast reveal distinct clinicopathologic and oncoprotein expression features compared with non-mucinous carcinoma and, therefore, it seems reasonable to suggest different biologic characteristics and manifestations.
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MESH Headings
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/pathology
- Adult
- Biomarkers, Tumor/analysis
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- DCC Receptor
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Prognosis
- Receptor, ErbB-2/analysis
- Receptors, Cell Surface/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Tumor Suppressor Protein p53/analysis
- Tumor Suppressor Proteins/analysis
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Affiliation(s)
- Yung-Hsiang Hsu
- Department of Pathology, Buddhist Tzu Chi General Hospital and University, Hualien, Taiwan.
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Lam WWM, Chu WCW, Tse GM, Ma TK. Sonographic Appearance of Mucinous Carcinoma of the Breast. AJR Am J Roentgenol 2004; 182:1069-74. [PMID: 15039190 DOI: 10.2214/ajr.182.4.1821069] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the sonographic and mammographic features of mucinous carcinoma and to correlate the imaging features with two histologic classifications. MATERIALS AND METHODS Two radiologists analyzed the mammographic and sonographic features of 33 mucinous carcinomas. Mammographic features according to the Breast Imaging Reporting and Data System (BI-RADS) and sonographic features were recorded and analyzed. The imaging features of the mass were correlated with the nuclear grade and mucin content of these 33 mucinous carcinomas. The incidence of axillary lymph nodes metastasis in different histologic grades and their detection by imaging were also assessed. RESULTS As many as 21.2% (7/33) of mucinous carcinomas could not be detected mammographically. When they were detected mammographically, more than 92% of the tumors presented as a mass, either oval or lobular. Microlobulations were present in 38.5% of these lesions. The margin of the lesion as seen on mammography can be used to predict the histologic grade. A circumscribed margin was associated with a favorable histologic grade (p = 0.01), whereas an indistinct margin was more commonly associated with the mixed type of lesion (p = 0.05). Sonographically, mixed cystic and solid components, distal enhancement, and microlobulated margins were commonly found in mucinous carcinomas, with an incidence of 37.5%, 43.8%, and 56.3%, respectively. Homogeneity on sonography was associated with the pure type of mucinous carcinoma and hence a better prognosis. Sonography showed a sensitivity of 50%, specificity of 89%, positive predictive value of 60%, negative predictive value of 84%, and accuracy of 79.2% in the detection of axillary lymph node metastasis. CONCLUSION Both sonographic and mammographic assessments are important in the correct diagnosis of mucinous carcinoma, the prediction of histologic grade, and the prognosis of the tumors.
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Affiliation(s)
- W W M Lam
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing St., Shatin, New Territories, Hong Kong
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Ruibal A, Arias JI. [Biological features characteristic of the mucinous carcinoma of the breast]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2003; 22:122-4. [PMID: 12646105 DOI: 10.1016/s0212-6982(03)72159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wong SL, Chao C, Edwards MJ, Carlson DJ, Laidley A, Noyes RD, McGlothin T, Ley PB, Tuttle T, Schadt M, Pennington R, Legenza M, Morgan J, McMasters KM. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg 2002; 184:492-8; discussion 498. [PMID: 12488144 DOI: 10.1016/s0002-9610(02)01057-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The need for axillary nodal staging in favorable histologic subtypes of breast cancer is controversial. METHODS Patients with clinical stage T1-2, N0 breast cancer were enrolled in a prospective, multi-institutional study. All patients underwent sentinel lymph node (SLN) biopsy followed by completion level I/II axillary dissection. RESULTS SLN were identified in 3,106 of 3,324 patients (93%). Axillary metastases were found in 35% and 40% of patients with infiltrating ductal carcinoma and infiltrating lobular carcinoma, respectively. Among tumor subtypes, positive nodes were found in 17% of patients with pure tubular carcinoma, 7% of patients with papillary cancer, 6% of patients with colloid (mucinous) carcinoma, 21% of patients with medullary carcinoma, and 8% of patients with DCIS with microinvasion. CONCLUSIONS Patients with favorable breast cancer subtypes have a significant rate of axillary nodal metastasis. Axillary nodal staging remains important in such patients; SLN biopsy is an ideal method to obtain this staging information.
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MESH Headings
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Awards and Prizes
- Axilla
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/surgery
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Female
- Humans
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Staging
- Sentinel Lymph Node Biopsy
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Affiliation(s)
- Sandra L Wong
- Department of Surgery, Division of Surgical Oncology, 315 E. Broadway, Suite 309, Louisville, KY 40202, USA
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Fujii H, Anbazhagan R, Bornman DM, Garrett ES, Perlman E, Gabrielson E. Mucinous cancers have fewer genomic alterations than more common classes of breast cancer. Breast Cancer Res Treat 2002; 76:255-60. [PMID: 12462386 DOI: 10.1023/a:1020808020873] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mucinous cancers of the breast are distinguished histologically by their abundant pools of mucin and low degree of nuclear pleomorphism. Relative to the more common breast cancers of no distinctive type (ductal carcinoma), mucinous cancers have a relatively favorable prognosis. In a study of chromosomal changes in mucinous cancers, we evaluated the extent of loss of heterozygosity (LOH) at chromosomal regions commonly deleted in usual infiltrating ductal carcinoma, including markers on chromosomal arms 1p, 1q, 3p, 6q, 8p, 9p, 11p, 11q, 13q, 16q, 17p, and 17q. Remarkably, we found an average frequency of LOH of only 1.9 of these 12 chromosomal arms in 18 cases of mucinous carcinoma, compared to an average frequency of LOH of 6.4 of these same chromosomal arms in cases of infiltrating ductal cancer. In three of the 18 cases of mucinous carcinoma studied, including one case with regional lymph node metastases, no LOH was seen at any of the 12 chromosomal regions studied. We considered the possibility of other chromosomal loci being more commonly affected in mucinous cancers and conducted comparative genomic hybridization on six of the cases. These studies demonstrated a low overall frequency of genomic copy number changes (mean of 3.1 changes per case) and failed to reveal any other chromosomal locus with frequent losses that had not been evaluated by microsatellite analysis. Together, these data indicate that mucinous cancers of the breast do not have the extensive genomic alterations that are typically found in more common variants of breast cancer. Thus, mucinous cancers most likely have less genetic instability than most other forms of breast cancer and the molecular pathogenesis of this form of breast cancer is likely to be substantially different than that of usual ductal breast cancer.
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Affiliation(s)
- Hiroaki Fujii
- Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan
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Lannigan AK, Going JJ, Weiler-Mithoff E, Cooke TG. Mucinous breast carcinoma. Breast 2002; 11:359-61. [PMID: 14965697 DOI: 10.1054/brst.2002.0417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2001] [Revised: 12/14/2001] [Accepted: 01/15/2002] [Indexed: 11/18/2022] Open
Abstract
A case of mucinous breast carcinoma is discussed in which several unusual features in presentation and difficulties in management are addressed.
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Affiliation(s)
- A K Lannigan
- Department of Surgery, Glasgow Royal Infirmary, UK
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Paramo JC, Wilson C, Velarde D, Giraldo J, Poppiti RJ, Mesko TW. Pure mucinous carcinoma of the breast: is axillary staging necessary? Ann Surg Oncol 2002; 9:161-4. [PMID: 11888873 DOI: 10.1007/bf02557368] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mucinous carcinoma of the breast (MCB) may be associated with a low risk of axillary metastases. METHODS To evaluate the incidence of axillary nodal metastasis in MCB, a review of all cases from January 1990 to July 2000 was performed. Pure MCB was defined as all tumor cells being completely surrounded by mucin. Patient demographics, tumor size, estrogen receptor status, total number of dissected lymph nodes, and incidence of nodal metastasis were studied. Deeper sections on the lymph nodes from the pure tumors were performed and stained with low-molecular cytokeratin. RESULTS Nineteen cases of pure MCB and 41 cases of mixed MCB were identified. Patients with pure MCB were older than those with mixed MCB. Tumor size and estrogen receptor status showed no statistically significant differences between the two groups. None of the patients with pure MCB demonstrated lymph node metastases, whereas 12 of 41 cases with mixed MCB demonstrated metastatic lymph node involvement. CONCLUSIONS Because pure MCB seems unlikely to metastasize, axillary lymph node staging in these patients may not be necessary. The presence of lymph node metastases strongly indicates the presence of a mixed MCB.
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Affiliation(s)
- Juan C Paramo
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
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Abstract
Evaluation of tissue and cellular samples for diagnosis, risk assessment, and prognosis in breast cancer is the subject of this review. We emphasize indicators of elevated risk for breast cancer and carcinomas in situ and indicators of good prognosis in invasive breast cancer. The importance of ductal carcinoma in situ to considerations in breast conservation and prevention is highlighted. Special types of breast cancer, immunohistochemistry, histologic grading, and the relevance of core biopsy to diagnostic certainty are considered. We also add a brief note about the escalating role of nodal micrometastases and sentinel node biopsy in the definition of minimal regional disease.
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Affiliation(s)
- J F Simpson
- Division of Anatomic Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Abstract
To investigate mucin expression in breast cancer, immunohistochemical staining was performed on 30 mucinous carcinomas and 95 non-mucinous invasive carcinomas. MUC2 expression was detected in all mucinous carcinomas, but only in 11.1% of invasive ductal carcinomas, and in none of the invasive lobular carcinomas and medullary carcinomas. MUC1 is often expressed in invasive breast carcinoma, but not in medullary carcinoma. Strong cytoplasmic staining was seen in invasive ductal carcinoma, in contrast to surface membrane staining in mucinous carcinoma and intracytoplasmic vacuole staining in invasive lobular carcinoma. CA19-9 and CA50 expression in more than 25% of tumor cells was seen in 17.2 and 16.0% of invasive ductal carcinomas, respectively, but not in mucinous carcinomas. CA125 and human gastric mucin were rarely expressed in breast cancer, irrespective of histologic type.
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Affiliation(s)
- J S Chu
- Department of Pathology, Taipei Medical College, Taiwan.
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